Managed Care

Freedom Health, Optimum Healthcare and Its Former COO to Pay $32.5 Million to Settle False Claims Act Allegations of Medicare Fraud

By the C|C Whistleblower Lawyer Team Yesterday, the Department of Justice and Constantine Cannon, LLP announced that they had reached a settlement with Freedom Health and Optimum Healthcare, two large health insurers and operators of Medicare managed healthcare insurance plans controlled by Dr. Kiranbhai “Kiran” C. Patel and based in Tampa, Florida, to resolve allegations of systemic Medicare and Medicaid...

May 30, 2017

Constantine Cannon serves as lead counsel representing whistleblower Dr. Darren Sewell in largest successful whistleblower settlement for claims of risk adjustment fraud at $16.7 million.  Total settlement against Freedom Health and Optimum Healthcare, two Florida Medicare Advantage plans, and former Chief Operating Officer Sidd Pagidipati exceeds $32 million.   Read the Constantine Cannon press release, the Dept....

United States Files Complaint-in-Intervention in Constantine Cannon Whistleblower’s Case Against UnitedHealth Group

The Department of Justice announced yesterday that it has filed a complaint-in-intervention against UnitedHealth Group (UHG) in a case brought by Constantine Cannon client Ben Poehling.  The government’s complaint alleges that UHG knowingly obtained inflated risk adjustment payments from Medicare Advantage based upon false information regarding the health of beneficiaries in its plans. UHG is the nation’s...

In Their Own Words -- Grassley

-- “By all accounts, risk score gaming is not going to go away.  Therefore, CMS must aggressively use the tools at its disposal to ensure that it is efficiently identifying fraud and subsequently implementing timely and fair remedies.  The use of these tools is all the more important as Medicare Advantage adds more patients and billions of dollars of taxpayer money is at stake.”

Chuck Grassley, urging CMS to...